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Review
. 2021 Jun;51(6):477-486.
doi: 10.4070/kcj.2021.0077.

The Importance of Arrhythmia Burden for Outcomes and Management Related to Catheter Ablation of Atrial Fibrillation

Paula Sánchez-Somonte  1 , Enes Elvin Gul  1 , Atul Verma  2
Affiliations
Review

The Importance of Arrhythmia Burden for Outcomes and Management Related to Catheter Ablation of Atrial Fibrillation

Paula Sánchez-Somonte et al. Korean Circ J. 2021 Jun.

Abstract

Atrial fibrillation (AF) ablation has been shown to be an effective treatment for AF, although our understanding of AF ablation outcomes until now, has been based on AF recurrence as a dichotomous variable. Reduction in AF burden, defined as the proportion of time that an individual is in AF during a monitoring period, has been already correlated to an improvement in quality of life and is likely a better assessment of success. Clinically, many patients may still have a few short recurrences of AF but feel much better. In addition, several studies have related higher AF burden with poorer health outcomes and a higher risk of stroke. Despite the growing understanding of AF burden, it is not clear yet which threshold of AF burden would be considered an appropriate outcome measure for AF ablation. Further investigations are needed to address that question. However, the reduction of AF burden seems to be a more accurate reflection of procedural success and a better predictor of prognosis and stroke risk than a single measure of AF.

Keywords: AF ablation; AF burden; Prognosis; Quality of life; Stroke.

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Conflict of interest statement

Dr. Atul Verma report the grant, personal fees, clinical trial from Medtronic, Biosense Webster, Bayer, Medlumics, and Adagio Medical. The other authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Figure from Mantovan et al. Change in 8 subscale values in the 36-Item Short Form Health Survey (SF-36) from baseline to 12 months after ablation for patients with recurrence of AF. Arrhythmia burden was split into quartiles. The quartiles were: 30 seconds to 30.8 minutes (Q1), 30.9 minutes to 1.3 hours (Q2), 1.4 hours to 4.7 hours (Q3), and 4.8 to 720 hours (Q4). For Q1 and Q2, there were significant improvements in the magnitude of change for each of the 8 subscales from baseline to 12 months. For patients in Q3, there was either significant improvement (p<0.03 for RP, SF, RE, and MH) or no significant change (PF, BP, GH, VI). For patients in Q4 there was a significant decrease in all subscales.
AF = atrial fibrillation; BP = body pain; GH = general health; MH = mental health; PF = physical functioning; RE = role emotional; RP = role physical; SF = social functioning; VI = vitality.
Figure 2
Figure 2. Figure from Terricabras et al. Patients with less than 90% AF burden reduction, experienced an improvement in QOL in 6 of the 8 subscales. Patients with less than 80% AF burden reduction, had an improvement in 4 of 8. For patients with less than 70% AF burden reduction, 3 of 8 scales and for patients with less than 60% AF burden reduction, 2 of 8 scales showed a statistically significant positive change.
AF = atrial fibrillation.
See this image and copyright information in PMC

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